title: Pure NOTES transvaginal appendectomy with gasless laparoscopy.
abstract: BACKGROUND
  The vagina is the most widely used approach to natural orifice transluminal endoscopic surgery. However, a gas leak can significantly affect transvaginal operations during pneumoperitoneum laparoscopy. We tried to establish the proper technique for transvaginal appendectomy under gasless laparoscopy.
  
  
  METHODS
  Five patients with chronic appendicitis were selected to receive gasless laparoscopic transvaginal appendectomy with concurrent vaginal hysterectomy. An abdominal wall-lifting device was applied after removal of the uterus, and the appendix was removed transvaginally. Clinical data such as operative duration, bleeding volume, morbidity, and hospital stay duration were analyzed.
  
  
  RESULTS
  All procedures were performed successfully, without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 20-30 minutes, with minimal blood loss. All patients were discharged, scar-free, 3 d after surgery.
  
  
  CONCLUSIONS
  Transvaginal appendectomy with gasless laparoscopy after vaginal hysterectomy appears to be a feasible and safe modification of established techniques, with acceptable outcomes.
authors.affiliation: Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Ying-Han
authors.initials: YH
authors.lastname: Chen
authors.forename: Dan-Bo
authors.initials: DB
authors.lastname: Wang
authors.forename: Yu
authors.initials: Y
authors.lastname: Tian
authors.forename: Shuo-dong
authors.initials: SD
authors.lastname: Wu
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D014621:Vagina
keywords: Gasless; Hysterectomy; Laparoscopy; Pure NOTES; Transvaginal appendectomy